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Dr. Robert Steven
Backstein, MD, FRCS(C) is a fully qualified
plastic and cosmetic surgeon who holds a
Fellowship in the Royal College of Surgeons of
Canada. He graduated and completed his plastic
surgery residency training at the University of
Toronto Medical School, and has been recognized
by multiple scientific publications in major
medical journals. Currently on staff at Humber
River Memorial Hospital, Toronto Ontario, Dr.
Backstein performs all surgery in a hospital
setting, with the option for a private clinic
setting available as well.
Please scroll page down to read Dr.Backstein's articles
on cosmetic surgery procedures.
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Tummy Tuck or Liposuction - Which Cosmetic Surgery Is Right
For Me?
A common
misconception amongst patients considering cosmetic
surgery of the abdominal area is that the choice exists to have either a tummy tuck or
liposuction and that either of these two procedures will
produce similar results. In most cases, a
patient is a far better candidate for either a tummy
tuck or liposuction and the procedures are not
interchangeable. The decision as to which plastic
surgery procedure is best must be made in conjunction
with a qualified plastic surgeon but the following is a
general guideline: Typically, patients whose abdominal
area has loose excess skin, or significant stretch marks
will need a tummy tuck and will not benefit
from liposuction alone. This is because liposuction is a
procedure that only removes fat. Skin is
esentially unaffected. Therefore if there is substantial
loose skin or stretch marks to start with, liposuction will not remove any of the extra skin
or any of the stretch mark-bearing skin. Furthermore,
liposuction in these circumstances can actually
worsen the problem by removing the "foundation" on which
the skin rests, i.e. the underlying fat thereby
leaving even looser skin than the patient started with.
Liposuction to the abdominal area is more
appropriate in cases of younger patients with firm, taut
abdominal skin whose main problem is extra fat.
In these cases, skin reliably shrinks over the
liposucked area and a great cosmetic result can
be obtained. Remember that this is only a guideline. The
ultimate decision as to which procedure(s) is
best for you should be made during a private
consultation with a qualified
surgeon.
Who is a Candidate for a Tummy
Tuck?
A tummy tuck
can benefit individuals with the following features of
the abdominal area:
(1) excessive, loose, sagging
skin (2) stretch marks, such as after
pregnancy (3) excess fat on the abdomen (4) a
rounded tummy that would benefit from
flattening
How is a Tummy Tuck
Done?
A tummy tuck
involves multiple surgical steps, each designed to
enhance the cosmetic appearance and feel of
your abdominal area. The tummy tuck starts by making
an incision low down on the abdominal wall. Dr.
Backstein places this incision as low down as
possible so that it is generally not detectable in a
bathing suit or a bikini. Depending on your
body structure, fully hiding the incision scar may not
be feasible. Following the initial incision, a tummy
tuck will involve plication (firm tightening) of the
muscle layer, excision and removal of as much
excess skin and fat as possible, and placement of the
umbilicus (belly button) into an anatomically
pleasing location on the abdominal wall. Dr. Backstein
includes liposuction of the upper abdominal area
and love handles as part of the tummy tuck
procedure.
Tummy Tuck Cosmetic Surgery
Scars.
There are two
scars that are left by a tummy tuck. These are a
horizontal scar placed low down above the pubic
area and a circular scar carefully placed around the
belly button. Both of these scars are absolutely
needed if a tummy tuck is to be done properly and
effectively. Any procedure that attempts to
avoid these scars will always compromise
the result of the surgery in terms of tightening, flattening, and overall abdominal
beauty. Scars in general are dynamic. This means that
scars go through phases during which the visibility of
the scar changes from more to less. During the
first two months after a tummy tuck or liposuction,
scars will usually have a certain amount of
redness to them. This is called the inflammatory phase
of wound healing. Following this, for up to a
full year, the scars will fade more and more. It is
important to note that healing of surgical incisions is
very much an individual trait much like hair colour or skin tone. People will heal incisions and form
scars differently even when undergoing the exact same
surgery done by the same surgeon. As a rule,
patients are so thrilled and excited by the dramatic flattening of their abdomens and the psychological
lift that this provides that tummy tuck scars are
quickly overlooked and
ignored.
Tummy Tuck
Recovery.
How Much Pain Will I
Have?
Following a
tummy tuck, patients describe a major feeling of
tightness around the abdomen. The discomfort is
described as an intense muscle ache similar to the
feeling after an aggressive abdominal workout.
Dr. Backstein feels that the best tummy tucks will cause
a certain amount of post operative discomfort.
This is related to the extent of tightening that the
surgeon has achieved. If a tummy tuck doesn't
hurt at all, the abdomen was likely not tightened
adequately. Swelling and bruising is always seen zzz
after a tummy tuck or liposuction. Dr. Backstein always
provides supplemental liposuction to the upper
abdominal area and love handles and bruising will be
seen in these areas.
Do I Need To
Stay Overnight?
Most patients
are able to leave the hospital on the evening of the
surgical day. Arrangements can always be made
for patients to stay overnight if so desired. Although
straining, heavy lifting and bending should be
avoided, tummy tuck patients must start minimal walking
and leg exercises the day of the surgery. Lying in bed for hours at a time is dangerous and must be
avoided to minimize the risk of blood clots. When going to sleep, a couple of pillows under the knees
and behind the head will act to ease the tension on the
surgical incision and will help relieve
discomfort.
When Can I Return To
Work?
Patients with
jobs that require significant physical activity
including bending, lifting, or quick movement will need about 4 weeks off before being able to return
to full duties comfortably. Those patients with jobs
not demanding physical activity can return to work after
2 weeks.
When Can I
Work Out?
Light work
outs involving exercises that do not strain the surgical
incision or the abdominal muscles can begin at
2-3 weeks. This includes brisk walking or stationary
bike riding. Heavier work outs including abdominal
crunches, sit-ups and running should not be attempted
for about 1 month.
Do I Need to Wear a Special
Garment?
Yes, tummy
tuck patients should wear a compressive corset provided
by Dr. Backstein for the first 3-4 weeks post plastic
surgery.
Complications
Associated with Tummy Tucks.
Significant
complications following a tummy tuck are rare. This is
very much related to the fact that a tummy tuck is
a superficial cosmetic surgery focusing on the skin and fat
and upper muscle layers and not involving major
or vital organs. All potential tummy tuck
complications will be reviewed with you in detail by Dr.
Backstein during your initial consultation.
These include:
- anesthesia
side effects and complications
- infections
- post-operative
bleeding
- incision
separation
- blood
clots
- slow
healing areas
Tummy Tuck: The Only Cure For Stretch
Marks.
One thing is
abundantly clear about stretch marks and that is that
absolutely no cream or topical ointments exist
to remove them. Stretch marks are scars that occur
within the substance of the skin when it is
exposed to excessive stretching or shearing force. The
abdominal area develops stretch marks during pregnancy due to the stretching of the skin by the
growing fetus in the womb. Just as no cream exists to
erase scars on the skin, none exists to eliminate
stretch marks either although there are many
products on the market that claim to do so. A tummy
tuck will remove about 90% of stretch marks from the
abdominal wall. As a rule of thumb, all the stretch marks below the level of the belly button
will be removed with the large piece of skin and fat
that is discarded during the tummy tuck
surgery. Moreover, the stretch marks that are above the
belly button get pulled far down on the
abdomen, just above the pubic area as part of the tummy
tuck procedure. This means that about 90% of
your stretch marks are removed completely and the rest
shift to a much less visible area. It truly is
fair to say that tummy tuck surgery is the only cure for
abdominal stretch marks.
The Effects
of Pregnancy On Tummy Tuck
Surgery.
It is all too
clear that pregnancy induces unwanted changes in the
abdominal area that often lead people to
seeking surgical improvement. These pregnancy-induced
changes include general weight gain, looseness
and laxity of abdominal skin, and of course, stretch
marks. A tummy tuck operation is the very best
surgical procedure to dramatically improve all of the
above mentioned changes of the abdominal
region. Unfortunately, much of the improvement achieved
through a tummy tuck can, at least in part, be
diminished by the effects of subsequent pregnancy. It is
important to remember that our bodies are
dynamic and constantly changing. The beneficial effects
of tummy tuck surgery are not "carved in
stone", but need to be maintained. Pregnancy after a
tummy tuck will lead to generalized weight
gain, and stretching and distension of the abdominal
wall as the baby grows in the womb. This will
cause some degree of skin laxity and stretch marks
similar to that present prior to the tummy tuck
surgery. Your tummy area will,however, still look
better than it would have had you never undergone tummy tuck
surgery.
Exercise and Diet: Maintaining The Results of Your Cosmetic
Surgery.
The human
body is dynamic and always in a state of change. No
surgical procedure exists to reshape, recontour
or tighten a body region that is absolutely permanent.
The results of a tummy tuck and liposuction
need to be maintained. A healthy lifestyle must be
followed after surgery to maintain the dramatic
flattening and tightness of the abdominal region that a
tummy tuck or liposuction provides. Poor diet
and sedentary lifestyle will, over time cause weight
gain and skin stretching after tummy tuck
surgery. Happily, the vast majority of patients find
that after a tummy tuck or liposuction, they feel so
good both mentally and physically that
excercise and healthy eating become a welcome part of
their post surgical lifestyle.
Who is a Candidate for
Liposuction?
Liposuction is intended to treat
localized fatty deposits that are out of proportion with
your body as a whole. It should not be regarded
as a weight loss technique but rather a body contouring
procedure to remove fat collections that are
resistant to exercise and dieting. Liposuction can be
performed on many different body areas from the
face to the arms, abdominal area, and legs. Liposuction
is also an excellent approach to treating
gynecomastia, a condition in which a man develops
abnormally large breasts. Although it can be
performed in all age groups, liposuction results are
best in younger individuals with firm and
elastic skin. In cases with good skin elasticity, the
overlying skin will not become excessive or loose once liposuction has been performed. In patients
whose skin has lost elasticity, other procedures such as
a tummy tuck or thigh lift may be more
appropriate.
How Is
Liposuction Performed?
Liposuction can be performed either
under local or general anesthesia. It is almost always a
day surgery with no stay
required. Typically, liposuction involves multiple
small incisions which allow Dr. Backstein to first
infiltrate each area with solution containing
local anesthesia and a vasoconstrictor (to decrease
bruising) and then to aspirate unwanted fatty
deposits using a liposuction cannula. The duration of
the procedure depends on the amount of fat that
requires removal.
Liposuction
Recovery.
How Much Pain
Will I Have?
Liposuction is typically not overly
painful. Areas treated experience a dull ache that fades
over the first 7- 10
days.
Do I Need To
Stay Overnight?
Very few patients need to stay
overnight unless they are from out of town or have no
assistance at home.
When Can I
Return To Work?
Patients can return to jobs requiring
minimal physical activity after 3-7 days. Patients with
more rigorous jobs may need 2 weeks off prior
to resuming full duties
When Can I
Work Out?
Work outs can begin as soon as you
feel able and comfortable. This is usually after the
first week following liposuction
surgery.
Do I Need to
Wear a Special Garment?
Yes, liposuction patients should wear
a compressive garment provided by Dr. Backstein for the
first 3-4 weeks post
surgery.
Complications Associated With
Liposuction Plastic Surgery
Unfortunately, liposuction has
received somewhat of a bad rap in the media. When done
properly by a qualified plastic surgeon,
liposuction should be a safe procedure. Most of the
"horror stories" that one hears about through the media
are easily explained. These cases can usually
be attributed to unqualified medical practioners trying
there hand at liposuction or cases in which overzealous surgeons remove too much fat in a
single liposuction procedure. Complications
associated with liposuction
include:
- bruising
- swelling
- blood
clots
- irregularities
in contour (1-5 of every 100 patients will need a
minor touch up)
During your consultation, Dr.
Backstein will review the complications associated with
liposuction in great detail. When done
correctly, liposuction is a safe procedure with
excellent body contouring
results.
Is Liposuction
Dangerous?
Liposuction has been at the centre
of several high profile cases in which patients have
died or had terrible cosmetic
outcomes. In my opinion, for the major reason for this
is that liposuction is a rather unique cosmetic
surgery procedure in that the liposuction machine does a great
deal of the work involved with the liposuction procedure.
Classic cosmetic surgery skills and techniques such as surgical
dissection, meticulous incisions and suturing (stitching) do not
play a large role in a liposuction
procedure. Because of this, many untrained (ie.
no Royal College of Canada certification in Surgery) doctors have
developed unfounded confidence to purchase liposuction equipment
and perform liposuction procedures in their offices.There are
several doctors in Toronto and the GTA that
have large practices in cosmetic surgery
but are not qualified surgeons. Always remember to ask your
doctor for his or her qualifications and make sure they
are board certified in surgery.
Can
Liposuction Remove Cellulite?
Unfortunately,
the answer is no. Contrary to popular belief,
liposuction is not an effective treatment for cellulite. Cellulite is a dimpled appearance of the
skin similar to the texture of an orange peel that is a
result of fibrous attachiments of the underside
of the skin to the underlying muscles. Cellulite is not
only found in people that are over weight but
is also seen in fit and slim individuals. Because
cellulite is not a result of excess body fat,
liposuction is not effective in treating it. In fact
there is no proved treatment for cellulite. All
of the creams and topical ointments advertised on
television are of little to no use for treating
cellulite. A more recent treatment called endermology
attempts to treat cellulite using a
roller/suction device but the results are highly
questionable and likely not significant. In short, we
don't have a very good treatment for the problem of
cellulite. Liposuction should not be advertised
to patients as a means to treat cellulite because it
will not work.
Other Liposuction Information care
of the US Food And Drug Adminstration
(FDA):
What is Liposuction?
Liposuction is a
surgical procedure intended to remove fat deposits and
shape the body. Fat is removed from under the skin with
the use of a vacuum-suction canula (a hollow pen-like
instrument) or using an ultrasonic probe that emulfsies
(breaks up into small pieces) the fat and then removes
it with suction.
Persons with
localized fat may decide to have liposuction to remove
fat from that area. Liposuction is a procedure for
shaping the body and is not recommended for weight loss.
Liposuction may be
performed on the abdomen, hips, thighs, calves, arms,
buttocks, back, neck, or face. A liposuction procedure
may include more than one site, for instance, the
abdomen, back, and thighs all on the same
day.
Liposuction is also
used to reduce breast size in men with large breasts
(gynecomastia) or to remove fat tumors (lipomas) but it
is most commonly used for cosmetic body shaping.
Who Performs Liposuction & Where is
Liposuction Performed?
Many
liposuction surgeries are performed by plastic surgeons
or by dermatologists. Any licensed physician may perform
liposuction. While some physicians' professional
societies may recommend training before performing
liposuction surgery, no standardized training is
required. As a result, there will be differences in
experience and training in physicians performing
liposuction. You can ask your physician to tell you
whether he or she has had specialized training to do
liposuction and whether they have successfully done
liposuction before. But remember, even the best screened
patients under the care of the best trained and
experienced physicians may experience complications as a
result of liposuction.
Liposuction
may be performed in a
- doctor's
office.
- surgical
center.
- hospital.
Because
liposuction is a surgical procedure, it is important
that it be performed in a clean environment. Emergencies
may arise during any surgery and access to emergency
medical equipment and/or a nearby hospital emergency
room is important. These are things that you should ask
your physician before the liposuction.
How can I find the right doctor for
me?
The FDA
cannot recommend physicians to you. However, there are
some things that you may consider:
- Ask
questions. If you decide to take the step to talk
to a doctor about liposuction, be sure that you ask
questions and understand what happens during the
liposuction procedure and what you can expect. Your
physician should also answer any and all questions you
have about potential problems with liposuction.
Remember that you are purchasing a service when you
pay a physician to do a liposuction procedure and you
shouldn't feel embarrassed to ask hard questions about
the procedure or about the physician's experience in
performing liposuction.
- Advertising.
Be wary of advertisements that say or imply that you
will have a perfect appearance after liposuction.
Remember that advertisements are meant to sell you a
product or service, not to inform you of all the
potential problems with that service.
- Don't
base your decision simply on cost and remember
that you don't have to settle for the first doctor or
procedure you investigate. The decision you make about
liposuction surgery is an important one but not one
that you must make right away.
- Read. You
should learn as much as you can about liposuction. It
is important for you to read the patient information
that your doctor provides.
- Don't
be pressured. Do not feel that because you speak
to a physician about this procedure that you must go
through with it. Take your time to decide whether
liposuction is right for you and whether you are
willing to take the risks of undergoing liposuction
for its benefits.
You are
probably NOT a good candidate for liposuction surgery
if:
- You
are not a risk taker. Certain complications are
unavoidable in a percentage of patients, and there are
no long-term data available for current
procedures.
- Cost
is an issue. Most medical insurance will not pay
for cosmetic liposuction. The cost for liposuction may
be significant.
- You
are overweight or obese and trying to lose weight.
Liposuction is a procedure for shaping the body and is
not recommended for weight loss.
- You
have a disease or are on medication that affects wound
healing. These include current infection or past medical
history of bleeding, emboli, thrombophlebitis, edema, or if you are taking
medication(s) that may affect your wound healing or
blood clotting (such as aspirin, nonsteroidal
anti-inflammatory agents, warfarin, heparin, or other
anticoagulants) or are taking medication that may
interact with the drugs used during
liposuction.
- Your
skin elasticity is not adequate. Your doctor will
evaluate the skin at the site where you are
considering liposuction to determine if skin is
elastic enough to shrink after liposuction. If it is
not, it will be baggy after liposuction.
What are the Alternatives to
Liposuction?
Liposuction
is usually cosmetic surgery so is not considered
medically necessary (there are rare exceptions to this).
Because of this, it is you who will decide
whether or not you will undergo this procedure. You may
decide that liposuction is not right for you. You may
make this decision without consulting a physician or
after consulting with a physician. A consultation with a
physician does not obligate you to have liposuction if
you decide that you do not want to.
What are
the Risks or Complications Associated withLiposuction?
Risks
Most
patients are pleased with the outcome of their
liposuction surgery. However, like any other medical
procedure, there are risks involved. That's why it is
important for you to understand the limitations and
possible complications of liposuction surgery. Before
you have liposuction, you should be aware of these risks
and should weigh the risks and benefits based on your
own personal value system. Try to avoid being influenced
by friends that have had the procedure or doctors
encouraging you to do so. Decide for yourself whether
you are willing to take the risks involved in
liposuction.
Take your
time deciding if you are willing to accept the risks
inherent in liposuction. Because it is usually a
cosmetic procedure, and not medically necessary, there
is no reason to rush. Gather as much information as you
can so that you make an informed decision about whether
liposuction is right for you. Don't believe that
complications "only happen to other people." It is
important for you to understand what the risks are and
decide if you are willing to accept the possibility that
it might happen to you.
Complications
- Infections.
Infections may happen after any surgery and may occur
after liposuction. Some physicians prescribe an
antibiotic to all patients undergoing liposuction but
other physicians do not. It is important to keep the
wound(s) clean but even if you do, infections may
sometimes occur from the surgery. Sometimes,
infections may be serious or life threatening such as
in cases of necrotizing fasciitis (bacteria eat away
at the tissue) or with toxic shock syndrome, a
serious, sometimes fatal infection caused by a
bacteria, that is associated with surgery (you may
have heard of toxic shock syndrome occurring in women
using tampons, also).
- Embolism.
Embolism may occur when fat is loosened and enters the
blood through blood vessels ruptured (broken) during
liposuction. Pieces of fat get trapped in the blood
vessels, gather in the lungs, or travel to the brain.
The signs of pulmonary emboli (fat clots in the lungs)
may be shortness of breath or difficulty breathing. If
you have the signs or symptoms of fat emboli after
liposuction, it is important for you to seek emergency
medical care at once. Fat emboli may cause permanent
disability or, in some cases, be fatal.
- Visceral
Perforations (puncture wounds in the organs).
During liposuction, the physician is unable to see
where the canula or probe is. It is
possible to puncture or damage internal organs during
liposuction. This may happen, for instance, if the
intestines are punctured during abdominal liposuction.
When organs are damaged, surgery may be required to
repair them. Visceral perforations may also be
fatal.
- Seroma.
After liposuction, there may be a pooling of serum,
the straw colored liquid from your blood, in areas
where tissue has been removed.
- Nerve
Compression and Changes in Sensation. You may
experience "paresthesias" which is an altered
sensation at the site of the liposuction. This may
either be in the form of an increased sensitivity
(pain) in the area, or the loss of any feeling
(numbness) in the area. If these changes in sensation
persist for a long period of time (weeks or months)
you should inform your physician. In some cases, these
changes in sensation may be permanent.
- Swelling.
Swelling or edema may occur after
liposuction. In some cases, swelling may persist for
weeks or months after liposuction.
- Skin
Necrosis (skin death). The skin above the
liposuction site may become necrotic or "die." When
this happens, skin may change color and be sloughed
(fall) off. Large areas of skin necrosis may become infected with bacteria or
microorganisms.
- Fluid
Imbalance. Fat tissue, which contains a lot of
liquid, is removed during liposuction. Also,
physicians may inject large amounts of fluids during
liposuction. This may result in a fluid imbalance.
While you are in the physician's office, surgical
center or hospital, the staff will be watching you for
signs of fluid imbalance. However, this may happen
after you go home and can result in serious conditions
such as heart problems, excess fluid collecting in the
lungs, or kidney problems as your kidneys try to
maintain fluid balance.
- Toxicity from
Anesthesia. Lidocaine, a drug that numbs the skin,
is frequently used as a local anesthetic during
liposuction. You may have had a similar drug,
novocaine, to numb your mouth at the dentist. Large
volumes of liquid with lidocaine may be injected
during liposuction. This may result in very high doses
of lidocaine. The signs of this are lightheadedness,
restlessness, drowsiness, tinnitis (a ringing in the
ears), slurred speech, metallic taste in the mouth,
numbness of the lips and tongue, shivering, muscle
twitching and convulsions. Lidocaine toxicity may
cause the heart to stop. Of course, this can be fatal.
In general, any type of anesthesia may cause
complications and is always considered a risk during
any surgery.
- Fatalities
Related to Liposuction. There are numerous reports
of deaths related to the liposuction procedure.
Although it is difficult to be sure how often death
from liposuction happens, there are several studies
that estimate how often patients undergoing
liposuction die during the procedure or as a result of
it. None of the studies is perfect so the results are
just estimates.
Some of
the studies indicate that the risk of death due to
liposuction is as low as 3 deaths for every 100,000
liposuction operations performed. However, other
studies indicate that the risk of death is between 20
and 100 deaths per 100,000 liposuction procedures. One
study suggests that the death rate is higher in
liposuction surgeries in which other surgical
procedures are also performed at the same time. In
order to understand the size of the risk, one paper
compares the deaths from liposuction to that for
deaths from car accidents (16 per 100,000). It is
important to remember that liposuction is a surgical
procedure and that there may be serious complications,
including death.
What can I
Expect Before, During, and After Liposuction?
Before...
Before you
undergo liposuction, you should undergo a complete
physical exam so that your doctor can determine if you
are an acceptable candidate for liposuction. It is
important for you to discuss any medical conditions that
you have and to tell your doctor about any medications
that you are taking including any herbal or other
non-prescription ones. If your doctor decides that you
can have liposuction, discuss the procedure thoroughly
with him or her before deciding if you want to go
through with the procedure. Just because a physician
says that you may have liposuction does not mean that
you must decide to have liposuction. You may still
change your mind even after discussing the procedure
with a physician.
Your
physician should be able to answer any questions that
you have about liposuction including questions about
what to expect during and after liposuction and the
complications or problems that sometimes occur with
liposuction. Some physicians will provide written
information about liposuction. You may also take
information from this website to your appointment to
discuss with your physician.
You may
want to have someone drive you to your appointment for
liposuction. You may be tired or uncomfortable after
liposuction and unable to drive yourself home. Discuss
this with your physician before the day of your
procedure.
Your
physician may prescribe an antibiotic drug for you to
take before and after the surgery. This is to prevent
infections.
During…
On the day
of the liposuction surgery, the physician will mark your
body with a pen to indicate where the fat is to be
removed. Then you will receive anesthesia, that is
medicine that prevents you from feeling pain. Some
physicians use only local anesthesia, that is,
anesthesia that they inject with a syringe or pump into
the area where they will do the liposuction. The
anesthesia medicine is injected along with a lot of
fluid, usually buffered salt water and epinephrine, a
drug to reduce bleeding. Large volumes of liquid may be
injected, until the skin is very firm. If your physician
uses only this kind of local anesthesia, also sometimes
called tumescent anesthesia, then you will be awake
during the procedure. Other physicians use local
anesthesia and a sedative that can be taken by
mouth or injected from a syringe. Still others prefer to
use general anesthesia, that is to use anesthesia that
will put you to sleep during the procedure. This is
usually done in a hospital.
Once the
anesthesia is working, the physician will make an
incision (cut) in the area where the liposuction will be
performed. A canula, a hollow tube that is about the
size and shape of a skinny pen, will be inserted into
the incision. The physician moves this canula back and
forth to suction out the fat. The fat, and liquid that
has been injected, are collected in a flask. The
physician will monitor the amount of fluid and fat that
are removed. Because you will be losing liquid and fat
from your body, it may be necessary to replace some of
that fluid. This is done with an intravenous (i.v.) line
for the replacement of fluid.
After…
Depending
upon the amount of fat removed and the location of the
surgery (doctor's office, surgical center, hospital),
you may leave the doctor's office soon after the surgery
or you may spend the night in the surgical center or
hospital. Ask your doctor how long it will be before you
should be able to return to your normal level of
activity or if you will need to miss work after
liposuction.
The cuts
where the doctor inserted the canula may be leaky or
drain fluids for several days. In some cases, the doctor
may insert a drainage tube to drain fluid away from the
wound.
You will
wear special tight garments to keep your skin compressed
after the liposuction procedure. Your doctor will tell
you how long to wear these, usually for weeks. Some
doctors provide these garments but others will tell you
where to purchase them before your surgery.
Your doctor
will also probably give you some after-surgery
instructions. This will include information about
wearing compression garments, taking an antibiotic if
that has been prescribed, and the level of activity that
is safe for you after your liposuction procedure. You
should also have information about signs of problems
that you should be aware of, for instance the signs of
infections or other problems
that you need to know about.
When the
anesthesia wears off, you may have some pain. If the
pain is extreme or of a long duration, you should
contact your physician. You will also have some swelling
after the surgery. In some cases, this swelling will
remain for weeks or even months. If you have pain and
swelling, this may be the sign of infection and you
should contact your physician.
You will
have scars, usually small, where the physician cuts your
skin and inserts the canula to remove fat
tissue.
Will I look the way I want after
liposuction?
While
medical complications are important, the reason that
people have liposuction surgery is for cosmetic reasons.
The cosmetic effect after liposuction may be very good
and many patients report being satisfied. However, it is
possible that the cosmetic effect will not be what you
expected. In other words, your appearance after
liposuction may not be what you expected or wanted. Some
physicians counsel their patients that reasonable
expectations are important. It may be difficult to have
reasonable expectations after reading advertisements and
looking at pictures of women and men who have had
liposuction.Some cosmetic
shortcomings after liposuction include:
- There
may be scars at the site where the doctor made the cut
to insert the liposuction canula. These scars are
usually small and fade with time but in some people,
scars may be larger or more prominent.
- The
liposuction site may have a wavy or bumpy appearance
after liposuction.
- Liposuction
results may not be permanent. If you gain weight after
liposuction surgery, the fat may return to sites where
you had liposuction or to other sites.
- Results
may be less dramatic than what you were expecting and
this can be disappointing
Factors To Consider With Breast Implant
Surgery.
There are several factors to think
about prior to undergoing breast augmentation. These
are: the type of implant to be used (saline or
silicone), the incision, the plane of the implant (above
or below the chest muscle) and of course the size of the
implant. A relatively new issue that has arisen is the
choice a woman has in Canada to use silicone or saline
(salt water) implants. Silicone implants, prior to the
90's, were the implant most often used. In the early
90's controversy began to arise about the safety of
silicone implants. There were links made between
silicone implants and what we call connective tissue
disease such as lupus, scleroderma, pain syndromes etc.
The situation deteriorated to the point that silicone
implants were essentially banned and saline became the
only choice. In the last few years, silicone implants
have made a big comeback here in Canada. The reason that
this has been allowed to happen is that the excellent
scientific research that was done to investigate the
safety of silicone implants has found that there is NO
relationship between silicone and connective tissue
diseases. This is not to say that women who were
complaining of being sick were not really sick, but that
there was no cause and effect relationship between their
silicone implants and their symptoms. What the studies
found in essence was that the incidence of connective
tissue disease was the same in groups of women who had
and who did not have silicone implants. Unfortunately,
it is human nature (and very reasonable) for a young
woman who was previously healthy and then went on to
develop disease to associate her new medical condition
with silicone implants. What we know now is that this
same woman was destined to fall into the larger group of
women overall who are destined to develop the disease
whether or not she had implants. Having said all of
this, I by no means encourage or "push" silicone
implants on my patients. I do not work for the company
or get paid any royalties. In fact, I would encourage
any woman struggling with the idea of putting silicone
implants into her body to avoid them and use saline.
Cosmetic surgery should be a positive, uplifting
experience. A woman who will continuously worry about
her silicone implants is still best off going with
saline. The other side of the coin is that almost all
plastic surgeons would agree that silicone implants are
a better product in that they look and feel more like a
natural breast. They are a better replica of the human
breast and give a better esthetic result. At the end of
the day, a woman along with her family must take all of
this information into account and choose the implant
type that is best for her.
Other Breast
Implant Information care of the US Food And Drug
Adminstration (FDA):
Breast Implants Home
Page
Welcome to the FDA website on breast implants.
FDA’s mission is to assure that the products that we
approve are safe and effective, and that includes breast
implants. Breast implants are medical devices that
typically consist of a silicone elastomer shell filled
with saline or silicone gel. They are intended for women
who are seeking breast augmentation (cosmetic) or breast
reconstruction.
We have provided information on this website to help
you make an informed decision as to whether or not to
get breast implants. There is information related to
both approved breast implants and investigational (under
study for safety and effectiveness) breast implants. The
information provided on this website is designed to
support, not replace, the relationship that exists
between you and your physician.
Silicone Gel-Filled Breast Implant Timeline
- Breast implants were
preamendments devices. With the passage of the Medical
Device Amendments to the Federal Food, Drug, and
Cosmetic Act in 1976, these devices were reviewed
through the premarket notification (510(k)) process.
In 1988, all breast implants were classified as class
III devices (premarket approval). However, in
accordance with the law, they continued to be reviewed
through the 510(k) process until FDA issued a rule
calling for submission of premarket approval
applications (PMAs).
- April 1991: FDA issued a final rule calling for
submission of PMAs for silicone gel-filled breast
implants.
- November 1991: A Panel meeting was held to discuss
several silicone gel-filled breast implant PMAs. A
voluntary moratorium was issued after the November
1991 Panel meeting, requesting that industry cease
marketing of silicone-gel filled breast implants while
FDA reviewed new safety and effectiveness information
that had been submitted. In February 1992, a second
Panel meeting was held to discuss that new
information.
- FDA concluded that none of the PMAs submitted at
that time contained sufficient data to support
approval. However, FDA found that the continued
availability of the devices for patients undergoing
breast reconstruction or replacement of existing
silicone gel-filled breast implants (revision) was
necessary for the public health. FDA determined that,
to address this public health need, access to silicone
gel-filled breast implants for reconstruction and
revision patients should continue to be available
through Adjunct Studies. FDA denied approval of the
devices for augmentation. Accordingly, silicone
gel-filled breast were no longer marketed in the U.S.
and were, thus, considered to be investigational
devices.
- July 1992: FDA approved Mentor's adjunct study
protocol for its silicone gel-filled breast implants
for reconstruction and revision patients only.
- March 1998: FDA approved Allergan’s (formerly
Inamed) adjunct study protocol for its silicone
gel-filled breast implants for reconstruction and
revision patients only.
- June 1998: FDA approved Allergan’s investigational
device exemption (IDE) study (i.e., Core Study) for
its silicone gel-filled breast implants for a limited
number of augmentation, reconstruction, and revision
patients at a limited number of sites. This is the
Core Study for P020056.
- August 2000: FDA approved Mentor's IDE study
(i.e., Core Study) for its silicone gel-filled breast
implants for a limited number of augmentation,
reconstruction, and revision patients at a limited
number of sites. This is the Core Study for
P0300053.
- December 2002: Allergan submitted a PMA (P020056)
for its silicone gel-filled breast implants.
- October 2003: FDA convened a Panel meeting to
review Allergan’s PMA (P020056). In a 9 to 6 vote, the
Panel recommended approvable with conditions.
- December 2003: Mentor submitted a PMA (P030053)
for its silicone gel-filled breast implants.
- April 2005: FDA convened a Panel meeting to review
Allergan’s updated PMA and Mentor’s PMA. In a 5 to 4
vote, the Panel recommended not approvable for
Allergan's PMA and, in a 7 to 2 vote, recommended
approvable with conditions for Mentor's PMA.
- July 2005: FDA issued an approvable letter to
Mentor for its silicone gel-filled breast implants.
- September 2005: FDA issued an approvable letter to
Allergan for its silicone gel-filled breast implants.
- November 2006: FDA issued letters to Mentor and
Allergan approving their PMAs for silicone gel-filled
breast implants.
FDA Approves Silicone Gel-Filled Breast
Implants After In-Depth Evaluation Agency Requiring 10 Years of Patient
Follow-Up
After rigorous scientific review, the U.S. Food and
Drug Administration (FDA) today approved the marketing
of silicone gel-filled breast implants made by two
companies for breast reconstruction in women of all ages
and breast augmentation in women ages 22 and
older. The products are manufactured by Allergan
Corp. (formerly Inamed Corp.), Irvine, Calif., and
Mentor Corp., Santa Barbara, Calif.
“FDA has reviewed an extensive amount of data from
clinical trials of women studied for up to four years,
as well as a wealth of other information to determine
the benefits and risks of these products,” said Daniel
Schultz, M.D., Director, Center for Devices and
Radiological Health, FDA. “The extensive body of
scientific evidence provides reasonable assurance of the
benefits and risks of these devices. This
information is available in the product labeling and
will enable women and their physicians to make informed
decisions.”
Now that the products have been determined to be safe
and effective, FDA will continue to monitor them by
requiring each company to conduct a large postapproval
study following about 40,000 women for 10 years after
receiving breast implants. FDA often requires
postmarket studies to answer important questions that
can only be answered once a product is in broader use,
such as the incidence of rare adverse events.
FDA’s decision to approve these implants was based on
a thorough review of each company’s clinical (core) and
preclinical studies, a review of studies by independent
scientific bodies and deliberations of advisory panels
of outside experts that heard public comment from
hundreds of stakeholders. In addition, FDA
conducted inspections of each company’s manufacturing
facilities to determine that they comply with FDA’s Good
Manufacturing Practices. Some of the complications
reported in the core studies included hardening of the
area around the implant, breast pain, change in nipple
sensation, implant rupture and the need for additional
surgery. However, the majority of women in these
studies reported being satisfied with their
implants.
In the past decade, a number of independent studies
have examined whether silicone gel-filled breast
implants are associated with connective tissue disease
or cancer. The studies, including a report by the
Institute of Medicine, have concluded there is no
convincing evidence that breast implants are associated
with either of these diseases. However, these
issues will be addressed further in the postapproval
studies conducted by the companies.
“The silicone breast implant is one of the most
extensively studied medical devices,” said
Schultz. “We now have a good understanding of what
complications can occur and at what rates. We also
know that women who get these devices will probably need
to have additional breast implant surgery at least
once. This is valuable information for women who
may be considering these products.”
Full information about the risks and benefits of the
devices can be found in the package and patient labeling
mandated by FDA. The patient labeling outlines
some of the important factors women should consider when
deciding whether to get silicone gel-filled breast
implants. Some of these factors are: breast
implants are not lifetime devices and a woman will
likely need additional surgeries on her breast at least
once over her lifetime; many of the changes to a woman’s
breast following implantation are irreversible; rupture
of a silicone gel-filled breast implant is most often
silent, which means that usually neither the woman nor
her surgeon will know that her implants have ruptured;
and a woman will need regular screening MRI examinations
over her lifetime to determine if silent rupture has
occurred. The device labeling states that a woman
should have her first MRI three years after her initial
implant surgery and then every two years
thereafter. The cost of MRI screening over a
woman’s lifetime may exceed the cost of her initial
surgery and may not be covered by medical
insurance. The labeling also states that if
implant rupture is noted on an MRI, the implant should
be removed and replaced, if needed.
FDA approved the silicone gel-filled breast implants
with a number of conditions, including requiring each
company to: conduct a large postapproval study; continue
its core study through 10 years; conduct a focus group
study of the patient labeling; continue laboratory
studies to further characterize types of device failure;
and track each implant in the event, for example, that
health professionals and patients need to be notified of
updated product information.
The postapproval studies will continue to gather
information about the safety and effectiveness of the
implants. Information will be collected about
rates of local complications, rates of connective tissue
disease and its signs and symptoms, rates of
neurological disease and its signs and symptoms,
potential effects on offspring of women with breast
implants, potential effects on reproduction and
lactation, rates of cancer, rates of suicide, potential
interference of breast implants with mammography, and
MRI compliance and rupture rates.
The postapproval studies will be closely
monitored by FDA. FDA anticipates that data from the studies will provide
important information for patients and physicians, and may
lead to improvements in device labeling.
Techniques for Breast
Lifts.
There are two
main techniques to lift a sagging breast. These involve
using a breast implant to "fill out" the loose skin of a
drooping breast or surgical excision of extra breast
skin and tissue to create a tighter, more youthful
breast form. The advantage of using a breast implant
to lift the breast is that the scarring left from the
procedure is relatively minor, and no greater than when
standard breast augmentation is performed for breast
enlargement. A possible drawback of this technique
is that the breast will, of course, become larger in the
process of using an implant to lift it. To a certain
extent, the degree of lift that is achieved is directly
proportional to the size of the implant used. This means
that a very sagging breast may need a substantial size
implant to achieve significant lift and this, in turn,
will also make the breast larger in volume. If a
larger breast is not desired, the second breast lift
method can be used. This is in some ways similar to a
breast reduction surgery in which specific areas of
breast skin and tissue are removed in such a way that
when stitched, a lifting effect is created almost like
an internal bra. The disadvantage of this technique is
that more incisions are required and this translates
into more scars left on the breast. Often a good
compromise, is a combination of a smaller implant and a
less extensive skin excision done at the same time. This
technique will allow the surgeon to achieve excellent
breast lift results while not enlarging the breast too
much and also not leaving as much scarring as a
skin excision breast lift alone.
Why Choose A Qualified
Cosmetic Plastic Surgeon?
These days, there is a great deal of confusion
about who is a cosmetic surgeon.
When cosmetic surgery originated, it was
exclusively performed by plastic surgeons. Plastic
surgeons are physicians who have completed 5-7 years of
additional training in the specialty of Plastic &
Reconstructive Surgery. This specialty training is
essentially an apprenticeship done under the supervision
and guidance of senior plastic surgeons and encompasses
many areas of surgery that fall within the realm of
plastic surgery. These surgical areas include cancer
surgery, burn surgery, trauma, as well as cosmetic
surgery.
In recent years , other medical
specialties such as ENT surgeons, dermatologists, and
even family physicians have begun performing cosmetic
surgical procedures. Medical licensing boards in
Canada and the
United States
generally do not prohibit any doctor from performing the
surgical procedures of a cosmetic surgeon. This has lead
to some confusion on the part of patients as to who is
and who is not a certified cosmetic plastic surgeon.
Furthermore, many doctors that are not plastic surgeons
do not make this clear in their advertisements and
marketing tools.
ENT surgeons, also called facial plastic
surgeons, are comprehensively trained in facial surgery
and are qualified to perform these procedures as well as
to deal with any complications encountered. Other physicians
who perform cosmetic surgery procedures may, in fact,
not be plastic surgeons or surgeons at all. While
complications can arise during or after cosmetic surgery
no matter who performs the procedure, a certified
cosmetic surgeon has a wealth of surgical training under
his or her belt to efficiently deal with surgical
complications such as bleeding, and post-operative
infections.
It is a patient’s right to know the precise
qualifications of any surgeon who advertises him or
herself as a cosmetic surgeon. Ask questions about
training and background to ensure that your cosmetic
surgeon is adequately trained in cosmetic surgery and
not a physician who unilaterally decided to become a
cosmetic surgeon years after their formal medical
training was completed.
Important Links:
Liposuction:
www.plasticsurgery.org
www.liposuction.com
www.lipoinfo.com
www.liposuction.com/lipoinfo/intro.php
www.liposuction.com/lipo_techniques/
www.liposuction.com/safety/
www.liposuction.com/pharmacology/
www.liposuction.com/postopcare/
www.liposuction.com/procedure/
www.liposuction.com/history/
womenshealth.about.com/cs/liposuction/
www.liposuctioninfo.org/
FDA
Consumer: The Skinny on Liposuction http://www.fda.gov/consumer/updates/liposuction082007.html
FDA
Consumer article on liposuction http://www.fda.gov/fdac/features/2000/600_flab.html
FDA website
for general consumer information http://www.fda.gov/default.htm
FDA website
for general consumer information on medical devices and
radiation-emitting products http://www.fda.gov/cdrh/index.html
The FDA
MedWatch site: safety information on drugs and other
medical products http://www.fda.gov/medwatch/
The Center
for Devices and Radiological Health site on reporting
problems with medical devices: http://www.fda.gov/cdrh/mdr.html
MEDLINEPlus
Health Information - Fat removal - by suctioning http://www.nlm.nih.gov/medlineplus/ency/article/002985.htm
MEDLINEPlus
Health Information - Liposuction - series: Indications
http://www.nlm.nih.gov/medlineplus/ency/presentations/100185_1.htm
Healthfinder - What
is Tumescent Liposuction? http://www.healthfinder.gov/docs/doc02193.htm
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